Autonomic dysreflexia during bowel evacuation procedures and bladder filling in subjects with spinal cord injury

Study design: Randomized, controlled clinical trial. Objectives: Bladder and bowel management may cause serious autonomic dysreflexia (AD) in subjects with high spinal cord injury (SCI). We aimed at investigating autonomic responses to digital rectal evacuation (DE), transanal irrigation (TAI) with...

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Bibliographic Details
Published in:Spinal cord 2014-06, Vol.52 (6), p.494-498
Main Authors: Faaborg, P M, Christensen, P, Krassioukov, A, Laurberg, S, Frandsen, E, Krogh, K
Format: Article
Language:English
Subjects:
692/699/1503/1581
692/699/2768/1337
692/699/375/1824
692/700/565
Adult
Aged
Anatomy
Autonomic Dysreflexia - etiology
Autonomic Dysreflexia - physiopathology
Biomedical and Life Sciences
Biomedicine
Blood Pressure - physiology
Enema
Epinephrine - blood
Female
Human Physiology
Humans
Male
Middle Aged
Neurochemistry
Neurogenic Bowel - physiopathology
Neuropsychology
Neurosciences
Norepinephrine - blood
original-article
Rectum - physiopathology
Spinal Cord Injuries - physiopathology
Spinal Cord Injuries - rehabilitation
Urinary Bladder - physiopathology
Urinary Bladder, Neurogenic - physiopathology
Urinary Catheterization
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Summary:Study design: Randomized, controlled clinical trial. Objectives: Bladder and bowel management may cause serious autonomic dysreflexia (AD) in subjects with high spinal cord injury (SCI). We aimed at investigating autonomic responses to digital rectal evacuation (DE), transanal irrigation (TAI) with 500 ml and filling cystometry (FC) in SCI. Setting: Aarhus University Hospital, Denmark. Methods: Eight subjects with SCI (AIS A) at or above T6 (high SCI) and a previous history of AD were compared with three subjects with SCI (AIS A) between T10 and L2 (low SCI). In randomized order, DE, TAI and FC were performed. AD was defined as an acute rise in systolic blood pressure (sBP) of ⩾30 mm Hg above baseline. Blood levels of norepinephrine and epinephrine were determined before and shortly after the procedures. Results: During all three procedures, AD occurred in all patients with high SCI but not in those with low SCI. In high SCI subjects, DE increased median sBP from 127 (range: 86–154) to 188 (range: 140–206) mm Hg ( P
ISSN:1362-4393
1476-5624
DOI:10.1038/sc.2014.45